What to Say to Those Who Think Single Payer Advocates Are Wacko

What to Say to Those Who Think Single Payer Advocates Are Wacko

by

Paul Hochfeld

What do we say to our more conservative friends, who genuinely think
that the Single Payer solution to our health care crisis would be a
disaster? Try what follows. In the end, you may simply agree to
disagree. That's O.K., but what follows may give them pause to think.

Already, 60% of all our health care dollars come directly or
indirectly (because employers insurance premiums are tax deductible)
from the taxpayer. The care of our oldest neighbors are financed by
Medicare, i.e. the taxpayers. The care of our disabled neighbors is
financed by Medicaid. Ditto the care of our poorest neighbors who,
because health follows wealth, are also at greater risk of high
expense. Fourteen hundred insurance companies, at significant expense,
stratify the rest of the population by "risk". Their top-secret
formula results in them covering the employed people, small groups, and
individuals who can prove that they are at low risk. What about the
others? When those who can't afford the premiums get sick, go
bankrupt, and can't pay their bills, "we" all pay for it in higher
charges. Furthermore, employer-paid premiums are tax deductible which
means insurance company profits are subsidized by the taxpayer.

As near as I can tell, this is a big taxpayer rip-off.
Additionally, our non-system is fraught with numerous perverse
incentives that result in more care, but not necessarily better care.
Physicians must share a significant part of the blame here, but that's
a different, though important, discussion. Addressing these
perversities is problematic because we don't have a Health Care System
we have For-Profit Sick Care Non-System that, to extent that it has any
design at all, is designed to serve the for-profit insurance and the
pharmaceutical industries. Perverse incentives work for those who
profit from them. They don't work for patients or those who pay the
bills, i.e., taxpayers.

Single payer means one risk pool. You've heard the slogan.
Everyone in. Nobody out. We gather all the money that employers and
individuals are currently paying for health care. It's not
more money. It's the same money, already being spent on health care,
but by pooling it, we can save 20% right off the top. Providers won't
have negotiate fee schedules with all the different payers. Providers
will only have to send bills, electronically, to one place.
Furthermore, substantial savings accrue as the system matures. When an
ER Doctor in Oregon sees a patient passing through town, he will access
her electronic medical record in Iowa, resulting in, not just less
expensive care, but better care. None of this is going to be
accomplished until we have Public Health Authorities administering a
health care system with the goal of health, financed publicly and delivered privately.

This isn't pie in the sky. Check out what the other developed
countries are doing, but please don't respond with anecdotes. We
have 45,000 new anecdotes every year that illuminate how real or
perceived financial barriers to timely, appropriate care cause
unnecessary death.

The real question is whose "system" produces the least number of
unnecessary deaths and the least suffering for the dollars being
spent? Yes, other countries are struggling because of limited
resources, but they are dealing with the problems maturely, they are
making difficult decisions, and, by recognizing that health is a human right, they are getting a healthier population for less cost.

Is access to appropriate health care a human right? If not, we can
agree to disagree. If so, it is a legitimate function of our
government to make sure that nobody falls through the cracks. Also,
doesn't the government have a fiduciary responsibility to make sure the
taxpayer is getting value for its health care dollars? Insurance
company CEO's have a fiduciary responsibility to maximize profits even
if it means investing large sums of money in manipulating public
policy... and that's exactly what they've been doing. It's
unfathomable to me that some people distrust "The United States" more
than United Health Care. That may be where we end up agreeing to
disagree.

Further

Lord, what would John Lennon have made of the Trump monster? Marking Thursday's 36th anniversary of Lennon's murder, Yoko Ono posted a plea for gun control, calling his death "a hollowing experience" and pleading, "Together, let's bring back America, the green land of Peace." With so many seeking solace in these ugly times, mourns one fan, "Oh John, you really should be here." Lennon conceded then, and likely would now, "Reality leaves a lot to the imagination."